New Therapy Could Decrease the Risk of Diabetes Related Birth Defects

While she was pregnant, my friend developed gestational diabetes. She caught it early though, and through proper diet and monitoring she was able to deliver a healthy baby. However, women with preexisting diabetes may have a harder time with carrying healthy children and the chances of their child developing birth defects are much higher.

The most common birth defects in children born to mothers with diabetes are caused by neural tube defects (NTDs), which occur when the fetal spinal column does not close completely in the first trimester. According to the U.S. Centers for Disease Control and Prevention, approximately 1 in 33 babies in the United States are born with a birth defect, and this number increases for women with preexisting diabetes to the point where these women are three to 10 times more likely to have children with NTDs or other birth defects.

Dr. Peixin Yang, associate professor in the Department of Obstetrics, Gynecology and Reproductive Sciences along with Dr. Dean E. Albert Reece, vice president for medical affairs at the University of Maryland, and Akiko K. Bowers, a distinguished professor and dean of the School of Medicine, led a recent study on how to reduce the chances of diabetic women having children with birth defects. "Providing the best possible care for women before and during early pregnancy is a significant challenge because the first trimester is such a crucial time of development, and many women may not be aware that they are pregnant," says Reece.

It was discovered that the method could lie in a cell signaling pathway that causes cell death, called apoptosis, which often results in NTDs. By recreating diabetic pregnancy in lab animals, researchers were able to determine that high levels of glucose caused apoptosis by activating a protein called apoptosis signal-regulating kinase 1 (ASK1). The team found that by inhibiting or removing the ASK1 gene, the chance of developing NTDs was greatly reduced.

Although much of the research was conducted with lab animals, the team is hopeful that the same treatment will be as effective in humans. They’re so optimistic about the therapy because the ASK1 inhibitor the team used is a small protein called thioredoxin which is produced naturally in humans.

"Because thioredoxin is small and naturally-occurring, it may be possible to develop it into a dietary supplement, much like folic acid, which women can take prior to and during pregnancy," says Dr. Yang. "Thioredoxin and folate might even have a combinational effect, providing greater protection for the fetus against NTDs, but also allowing women to take less folic acid, thereby preventing possible folate-induced damage to their children."

University of Maryland Medical Center (2013, August 28). New approach to prevent diabetes-induced birth defects?. ScienceDaily.

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BabyMed was created by Amos Grunebaum, MD FACOG. He is an obstetrician and gynecologist, Professor of Clinicial Obstetrics and Gynecology at New York's most prestigious Ivy League Medical School as well as a specialist in high-risk pregnancies (maternal-fetal medicine) with over 30 years experience in his field.